Programmed Cell Death Ligand 1 Expression in CD163 + Tumor-associated Macrophages in Cancer Gland Rupture Microenvironment.

In this study, we aimed to examine the relationship among cancer gland rupture microenvironment, programmed cell death ligand 1 (PD-L1) expression in CD163 + tumor-associated macrophages (TAMs), and prognosis in colon adenocarcinoma. A total of 122 patients were diagnosed with colon adenocarcinoma between 2010 and 2019. PD-L1 + (clone 22C3) "macrophage scores" in the microenvironment of cancer gland rupture were calculated. The effects of these variables on prognosis were statistically analyzed. CD163 + TAMs were denser in the cancer gland rupture microenvironment. PD-L1 + TAMs were observed in the tumor periphery, and there was a significant difference between the rates of PD-L1 expression in TAMs and survival time (log-rank = 10.46, P = 0.015), clinical stage 2 ( P = 0.038), and primary tumor 3 and primary tumor 4 cases ( P = 0.004, P = 0.013). The risk of mortality was 4.070 times higher in patients with a PD-L1 expression rate of ≥1% in CD163 + TAMs. High PD-L1 expression in CD163 + TAMs is associated with poor overall survival. Therefore, blocking PD-L1 in CD163 + TAMs can be used as a target for immunotherapy.

Clinicopathological and prognostic significance of PD-L1 expression in colon adenocarcinoma tumor budding.

OBJECTIVE: In this study, we investigated the relationship between programmed cell death ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) expression in colon adenocarcinoma tumor budding. METHODS: This study included 122 patients with colon adenocarcinomas. The largest sample of formaldehyde-fixed paraffin-embedded tumor tissues was selected for analysis. Expression of membranous PD-L1 (clone 22C3) and the Combined Positive Score (CPS) in tumor tissues was calculated and graded according to the percentages of peritumoral and intratumoral tumor cells (0 %, 1 %, 1-5 %, >5 %). The effects of these factors on the prognosis were analyzed. RESULTS: Tumor budding was associated with adverse clinicopathological features and poor overall survival. PD-L1 (CPS%) peritumoral tumor budding (1 %/<1 %) was statistically significant in the univariate model (p = 0.004). Age, organ metastases (liver, lung, liver, lung, and peritoneum), and metastases were statistically significant in the multivariate model (p = 0.001, p = 0.004, p = 0.001, p = 0.002, p = 0.004, and p = 0.032, respectively). PD-L1 positive staining was mostly observed around the tumor and during tumor budding. PD-L1 peritumoral tumor budding rates and patients' survival rates differed significantly (log-rank = 12.07, p = 0.007). CONCLUSION: We found that patients with PD-L1 (CPS%) > 1 % in tumor budding had a shortened life expectancy and demonstrated the importance of including tumor budding areas in the samples used for biomarker evaluation. We previously reported that PD-L1 expression in tumor budding is associated with more aggressive cancer biology and poor survival, although overall survival is of limited statistical significance.

Evaluation of Formalin-fixed Paraffin-embedded Tissue Samples Diagnosed by Histopathology as Echinococcus in Çorum

Objective: This study aimed to detect the presence of Echinococcus spp. in formalin-fixed paraffin-embedded (FFPG) samples of hydatid cyst cases and to discuss the DNA isolation problems in FFPG samples. Methods: FFPG samples of 47 cases diagnosed with hydatid cyst were included in this study. Demographic characteristics of the cases were investigated. Microtome sections were taken from the samples and deparaffinization, DNA extraction, polymerase chain reaction (PCR), and gel agarose electrophoresis procedures were performed. Results: Of the cases, 55.3% were female, whereas 45.7% were male. Average age was 45.47 and 68.1% of the cases were located in the liver, 17.0% in the lung, 12.8% in the abdomen, and 2.1% in the brain. DNA was obtained in only 11 (23.4%) of the FFPG cyst samples and no proliferation was detected in the PCR products of any of the sample. Conclusion: The scolex/germinal membrane' absence in the FFPG sections, intense inflammatory cell reaction, presence of fibrosis and stromal/parenchymal tissue, DNA damage due to formaldehyde action, long-term archiving, and insufficient amount of DNA obtained were considered as factors preventing DNA replication in PCR.

Clinical and pathological significance of programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) expression in high grade serous ovarian cancer.

We investigated programmed cell death 1 (PD-1) / programmed cell death ligand 1 (PD-L1) expression in high grade serous ovarian cancer (HGSOC) and its relationship to tumor infiltrating lymphocytes (TIL) and prognosis. Formalin fixed paraffin embedded (FFPE) samples of 94 HGSOC cases were included in the study. Immunohistochemical analysis (CD3, CD4, CD8, PD-1 and PD-L1) was performed. Samples were analyzed for expression of immune proteins in the peritumoral stromal and intratumoral areas, scored, and expression was correlated with overall survival, stage, and age. PD-L1 staining ratio with a score greater than 0 was found to have lower survival. There were two positive staining patterns, patchy/diffuse and patchy/focal patterns, in 24 (25.5%) cases. Considering the threshold value ≥5%, we demonstrated that the PD-L1 positive cancer cell membrane immunoreactivity rate and patchy/diffuse PD-L1 expression were 9.6% (n = 9). There was statistically significant relationship between high PD-1 scores and PD-L1 cases of ≥ 5%. A statistically significant difference was found between PD-L1 staining and survival in patients with a threshold ≥ 5%. However an appropriate rate for treatment was determined in 9.6% cases. There was a statistically significant correlation between PD-1 positive TIL score and intratumoral CD3, peritumoral stromal CD3, intratumoral CD4 and intratumoral CD8 positive cells. Survival was lower in cases with higher PD-L1 positive stromal TIL score.

Evolution of Telepathology: A Comprehensive Analysis of Global Telepathology Literature Between 1986 and 2017.

OBJECTIVE: Telepathology is an application of telemedicine providing remote evaluation and consultation of digital pathology images and can be used for educational or experimental purposes. Bibliometrics is a statistical discipline investigating publication patterns and trends in a certain academic field. Although bibliometric and scientometric studies are becoming increasingly popular, the relevant literature contains only one limited article related to telepathology. The aim of our study was to perform a holistic bibliometric analysis of the telepathology literature. MATERIAL AND METHOD: Since the first article on telepathology was published in 1986, we included all indexed articles retrieved from Web of Science databases between 1986 and 2017. RESULTS: We found that the USA covering 43.01% of all literature was the leading country in the telepathology field and was followed by Germany, Italy and the UK (n=120, 90 and 83, respectively). The countries with the most contributions were located in the continents of Europe and North America. The most productive source titles were Human Pathology, Journal of Telemedicine and Telecare, and Modern Pathology. Harvard University ranked first with 59 articles. The most commonly used keywords of the telepathology literature were "telepathology", "telemedicine", "digital pathology", "virtual microscopy" and "telecytology". We noted that all of the ten countries with the most contributions were in the developed category of UN classification and all twenty of the most productive institutions were from developed countries. CONCLUSION: We suggest that researchers from developing and least developed countries should be encouraged to carry out novel studies since telemedicine is a required and promising technology for rural developing or least developed areas in which access to health care is difficult.

Effect of high-risk human papillomavirus in esophageal squamous cell carcinoma in Somalian and Turkish cases.

This study aimed to investigate the role of high-risk human papillomavirus (Hr-HPV) in Somalian and Turkish patients with esophageal squamous cell carcinoma (ESCC). In the sections obtained from paraffin-embedded blocks, the results of invasive tumor, peripheral tumor dysplasia and normal mucosa were examined. Samples containing 45 and 47 ESCC, 46 and 42 dysplasia in Somalian (n = 52) and Turkish (n = 53) cases, respectively, were included in the study. We examined the presence of 14 types of Hr-HPV in ESCC collected from Somalia and Turkey by Aptima® Panther System. Hr-HPV types were not detected in Somalian cases. p16INK4a is positive in 5 (11.4%) tumors and 6 (13%) dysplasia. p53 is positive in 28 (62.2%) tumors and 35 (76.1%) dysplasia. HPV16-18/45 are positive only in one of the Turkish cases. p16INK4a is positive in 5 (10.6%) tumors and 4 (9.5%) dysplasia. p53 is positive in 31 (63.3%) tumors and 24 (57.1%) dysplasia. No reaction was detected in normal mucosa samples in both countries. This study is regional. Although the findings did not reflect the general population, the present study shows that the effect of HPV on carcinogenesis in Somalian and Turkish ESCC patients was not significant.

A Holistic Evaluation of Articles on PD-1 and PD-L1 Published Between 1975 and 2017: A Bibliometric Analysis.

BACKGROUND: Bibliometrics has been used for assessing and predicting trends in macro-health science and medical systems, especially in the field of cancer. Bibliometric and scientometric studies in the field of programmed cell death 1/programmed cell death 1 ligand 1 (PD-1/PD-L1) may guide further research in this field. OBJECTIVE: To perform bibliometric analysis of articles on PD-1 and PD-L1 published in the academic literature during 1975 to 2017. METHOD: The bibliometric analysis was performed using the Thomson Reuters Web of Science database. RESULTS: A total of 23 813 articles were retrieved, 73.52% of which were original articles. The United States was the leading country by total publication number (n = 10 897, 10.91%), followed by China (10.54%), and produced the most literature on PD-1/PD-L1 (164.65 articles). Among the institutions identified, Harvard University (USA) contributed the most articles on PD-1/PD-L1. CONCLUSIONS: All authors and institutions in the top 10 contributor's lists were from the developed countries. Researchers from the developing and least-developed countries should be encouraged to perform novel studies on PD-1 and PD-L1.

Experimental study on prophylactic effects of vardenafil in ischemia-reperfusion model with intestinal volvulus injury in rats.

AIM: An experimental study was performed to evaluate the effects of Vardenafil on ischemia-reperfusion (I/R) injury in an experimental volvulus model by histochemical and biochemical methods. MATERIALS AND METHODS: Thirty-five male Wistar rats were divided in five groups (n = 7). In Group 1, a 5 cm segment of small intestine 2 cm proximal to cecum was excised to have a control group. In the second group, 5 cm segment of small intestine 2 cm proximal to cecum was rotated 360° clockwise direction and sutured with 4/0 polyglactin to generate an experimental model of volvulus. At the end of 2 h of ischemia, the same intestinal segment was sampled. In group 3, after achieving ischemia similar to group 2, two hours of reperfusion injury was obtained by removing the sutures. Rats in Group 4 received vardenafil after 1.5 h of ischemia and then 2 h of reperfusion. And finally, in Group 5, vardenafil was administered 2 h before laparotomy and 5 cm of intestine was removed without I/R injury. Intestinal segments were evaluated for total antioxidant status (TAS), total oxidant status (TOS) and oxidative stress index (OSI) with biochemical and histopathological analysis. RESULTS: Serum TOS levels and OSI were not significantly different between groups (p = 0.910, P = 0,43 respectively). The serum TAS level was decreased in group 3 as compared to vardenafil groups 4 and 5, without a statistical significance (p = 0.428). In histopathologic analysis, we found that vardenafil, partially reduced I/R injury. The villus structure was preserved but, congestion and inflammation were moderate. CONCLUSION: Vardenafil partially reduced I/R injury histopathologically on intestine. Our study shows that it does not have statistically antioxidant effect on intestinal I/R injury in experimental model of volvulus. However, effects of vardenafil in I/R injury of liver, kidney, heart, testis, over and brain which were cited in literature were not confirmed with I/R injury on intestine.

Two-Year Results of Community-Based Screening Program for Human Papilloma Virus DNA in Çorum Province.

OBJECTIVE: The Turkish Ministry of Health started a community-based screening program using Human Papilloma Virus (HPV) DNA in 2014. In our study, we aimed to investigate the results of this survey in Çorum province between the years of 2016-17 to determine the shortcomings and deficiencies in practice. MATERIAL AND METHOD: All of the women between the ages of 30 and 65 years who had undergone High risk HPV DNA screening in Çorum province between 2016 and 2017 were included in the study. High risk HPV types were divided into three categories as type 16, 18 and others. The target group of patients to be screened were compared with the numbers reached in the survey. After colposcopic biopsy, the clinicopathological correlation of the patients who underwent colposcopic biopsy was determined via pathology reports. RESULTS: HPV DNA was detected in 817 women (3.5%). HPV types 16, 18 and others were found to be positive in 216, 32 and 569 individuals, respectively. Cervical biopsy was performed with colposcopy in 212 (26%) women. As the result of colposcopy, LSIL and HSIL were detected in 63 and 56 patients, respectively. 34.5% of patients with the diagnosis of any kind of dysplasia received treatments. CONCLUSION: It was determined that 44% of HPV DNA-positive patients were not subjected to the appropriate processes according to the national guidelines. This shows that despite the screening, the desired therapeutic effect could not be achieved.

The Female Genital Mutilation/Cutting Experience in Somali Women: Their Wishes, Knowledge and Attitude.

BACKGROUND: Female genital mutilation/cutting (FGM/C) is a common sociocultural practice in many communities in Africa. Unfortunately, what females are forced to accept because they are helpless, in order to be an individual in social life and in the country they live in, is an important health issue that is not only harmful to the human body but also against human rights. OBJECTIVES: This study aimed to investigate the wishes, knowledge and attitude of Somali women regarding FMG/C. METHODS: From 16 regions of Somalia, 356 women were randomly selected. A structured and interviewer-administered questionnaire was used to collect data. RESULTS: Except for one, all women participating in the survey were circumcised. A significant proportion of women embraced the continuation of FGM/C (52%) and 54.2% of them were satisfied with being FMG/C. Their knowledge, attitude, and practices were shaped by their religion and traditions. However, the proportion of those who wanted to stop FGM/C was 91%. CONCLUSIONS: Further efforts and research from different countries, cultures, beliefs, organizations, and individuals focusing on knowledge, awareness, legalization, and the opinions of lay and religious individuals, particularly including women's rights activists, and women with FGM/C, are needed to stop FGM/C, also known as female circumcision.

Neuroprotective effects of Quercetin on radiation-induced brain injury in rats.

Extensive research has been focused on radiation-induced brain injury. Animal and human studies have shown that flavonoids have remarkable toxicological profiles. This study aims to investigate the neuroprotective effects of quercetin in an experimental radiation-induced brain injury. A total of 32 adult male Wistar-Albino rats were randomly divided into four groups (control, quercetin, radiation, and radiation+quercetin groups, with eight rats in each group). Doses (50 mg/kg) of quercetin were administered to the animals in the quercetin and radiation+quercetin groups; radiation and radiation+quercetin groups were exposed to a dose of 20 Gy to the cranium region. Tissue samples, and biochemical levels of tissue injury markers in the four groups were compared. In all measured parameters of oxidative stress, administration of quercetin significantly demonstrated favorable effects. Both plasma and tissue levels of malondialdehyde and total antioxidant status significantly changed in favor of antioxidant activity. Histopathological evaluation of the tissues also demonstrated a significant decrease in cellular degeneration and infiltration parameters after quercetin administration. Quercetin demonstrated significant neuroprotection after radiation-induced brain injury. Further studies of neurological outcomes under different experimental settings are required in order to achieve conclusive results.

Cytological Findings of Malignant and Benign Head and Neck Masses in Somalia.

OBJECTIVE: There are no up-to-date records on head and neck masses (HNMs) in Somalia. This cytological study is the first to demonstrate the benefits and findings of fine-needle aspiration cytology in evaluating HNMs in the adult population of Somalia. STUDY DESIGN: A total of 116 aspiration samples were taken from different levels of the neck region, except for the thyroid. Cases were classified as salivary gland, lymph node, or soft tissue/cystic lesions. They were classified according to age, gender, and cytological diagnosis. RESULTS: Patients included 54 (46.6%) males and 62 (53.4%) females, with a mean age of 40.6 years. Seventy-two patients (62.1%) had benign lesions, while 44 (37.9%) had malignant lesions. Necrotizing granulomatous lymphadenitis (n = 51, 70.8% of the benign findings) and lymph node metastasis of squamous cell carcinoma (n = 13, 29.5% of the malignant findings) were the most frequent findings. CONCLUSION: Fine-needle aspiration is a useful procedure in the diagnosis of neck masses. It is a cheap and easy guiding method for diagnosing granulomatous lymphadenitis and advanced-stage metastatic cancers, which are common in this country.

The distribution of cancer cases in Somalia.

OBJECTIVE: The aim of this study was to investigate the frequency and distribution of cancer cases in a defined time period in Somalia. MATERIALS AND METHODS: A total of 403 cancer cases were diagnosed between January 01, 2016 and March 01, 2017 in the Department of Pathology at the Somalia Mogadishu-Turkey Education and Research Hospital or the Department of Oncology at Uniso Hospital, Somalia University. Data on cancer type, patient age, and gender were obtained from pathology reports and hospital records. RESULTS: Female patients totaled 49.6% (n = 200) and 50.4% of patients were male (n = 203). The youngest patient was 18 years of age, the oldest was 97, and the average age was 53.4 years. The 10 most common types of cancer were esophageal (n = 130, 32.3%), non-Hodgkin lymphoma (n = 35, 8.7%), liver (n = 26, 6.5%), breast (n = 24, 6.0%), skin (n = 17, 4.2%), thyroid (n = 13, 3.2%), brain (n = 12, 3.0%), bone (n = 11, 2.7%), colorectal (n = 11, 2.7%), and soft tissue (n = 11, 2.7%). The most common site of cancer in both males and females was the esophagus. CONCLUSION: These results show a high incidence of esophageal cancer in Somalia, and strongly suggest that environmental risk factors and nutritional habits have a strong impact in this population. Serious and extensive research on the etiology of esophageal cancer is required.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

A rare case of paratubal cystadenoma during pregnancy.

Paratubal cysts (PTCs) are generally incidentally detected in pregnancy. However, paratubal cystadenomas in pregnant women are very rare cases who are reported individually. An unusually giant case of paratubal cystadenoma in a pregnant woman is presented here. A 27-year-old woman presented to our department for a routine pregnancy checkup. A giant cystic mass accompanying a 17-week gestation was detected on examination. During laparotomy, a huge right-sided PTC was resected. Histopathological evaluation revealed a benign cystadenoma originating in the ipsilateral paratubal space. PTCs are often denoted as being benign. Neoplastic transformation or malign potential will change the course of follow-up and the patients' prognosis. Treatment with surgical excision in the second trimester can safely prevent such associated adverse conditions. In conclusion, gynecologists should be careful for causes of adnexal masses in a woman with an intrauterine pregnancy. PTCs also tend to show accelerated growth patterns during pregnancy.

Abdominal Sarcoidosis May Mimic Peritoneal Carcinomatosis.

Sarcoidosis is a multisystem inflammatory disorder of unknown etiology. It shows a great variety of clinical presentation, organ involvement, and disease progression. Lungs and lymphoid system are the most common sites involved with a frequency of 90% and 30%, respectively. Extrapulmonary involvement of sarcoidosis is reported in 30% of patients and abdomen is the most frequent site. Furthermore, peritoneal involvement is extremely rare in sarcoidosis. The case presented here described peritoneal manifestations of sarcoidosis without involvement of lungs. A 78-year-old woman possessing signs of malignancy on blood test and abdominal magnetic resonance imaging underwent laparatomy with a suspicion of ovarian malignancy. The macroscopic interpretation during surgery was peritoneal carcinomatosis. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal biopsies, total omentectomy, and appendectomy were performed. Final histopathological result revealed the diagnosis of sarcoidosis. Clinicians must keep in mind that peritoneal sarcoidosis can mimic intra-abdominal malignancies.

Colon perforation and Budd-Chiari syndrome in Behçet's disease.

BACKGROUND: Behçet's disease is a chronic inflammatory disease involving multiple systems, with vasculitis being the most important pathological feature. Multiple colon perforations are thought to be secondary to vasculitis and they occur in patients with ulcers. These may be encountered within the entire colon but most commonly in the ileocecal region. Intestinal perforation and Budd-Chiari syndrome are infrequent in Behçet's disease, and are associated with high mortality and morbidity. Budd-Chiari syndrome results from occlusion of either hepatic veins or adjacent inferior vena cava, or both. CASE REPORT: We report a patient with Behçet's disease having multiple perforations in the transverse colon, descending colon, and sigmoid colon. The patient also had Budd-Chiari syndrome due to inferior vena cava thrombosis extending into the right and middle hepatic vein. Our observations are presented with a review of the literature. CONCLUSIONS: In Behçet's disease, treatment of colon perforation necessitates urgent surgery, whereas management of Budd-Chiari syndrome is directed towards the underlying cause. Behçet's disease, as a chronic multisystemic disease with various forms of vasculitis, is resistant to medical and surgical treatment. Prognosis is worse in Behçet's disease with colon perforation than that in Budd-Chiari syndrome alone.

A rare cause of chronic cough: intrathoracic gossypiboma.

Intrathoracic gossypiboma, a retained surgical sponge in the thoracic cavity, is a rare but serious complication of thoracic surgeries. A 70-year-old man presented with an eight-month history of cough. He had undergone coronary artery bypass surgery eight years ago. The posteroanterior chest X-ray revealed a well-marginated homogeneous opacity at the left hemithorax with striped appearance in the center. Thoracic CT revealed a pleural-based mass at the left lower lobe with a hyperdense rim. After the diagnosis of gossypiboma, it was removed surgically. Although rare after thoracic surgery, gossypibomas need to be considered in the differential diagnosis in case of respiratory symptoms.

A study on distribution of cancer cases diagnosed in Çorum.

OBJECTIVE: In order to help obtain accurate knowledge and to contribute to the establishment of data for regional tumor statistics, we aimed to determine the frequency distribution of cancer cases that was diagnosed in Çorum province. MATERIAL AND METHOD: In this descriptive study, we retrospectively reviewed the archive records of the pathology departments' of one university hospital and two private hospitals serving in the province of Çorum. A total of 138,973 recorded pathology reports were reviewed. Metastatic cancers with a known primary source were excluded. A total of 2184 cases with a diagnosis of cancer were recorded by gender, age, and system/organ and classified to 10 most frequent types of cancer both in general and in terms of gender distribution. RESULTS: The male to female ratio was 1.44 and the mean age was 64.26 years. The cancer is most commonly encountered between 70 and 79 years of age (35.27%) in males whereas the second most common interval was 60 to 69 years of age (23.88%). In females, the cancer is most commonly encountered between 70 and 79 years of age (24.16%) whereas the second most common interval was 60 to 69 years of age (22.60%). The top five cancers were skin (33.60%), prostate (13.87%), stomach (9.07%), urinary bladder (8.61%) and breast (7.88%). CONCLUSION: Distribution of organ/system involvement of cancer cases that were diagnosed in Çorum is quite different from the data regarding Turkey in general. Development of cancer registry centers, upgrading to an active registry system and having all cancer data from health institutions unified in a single organization are mandatory to achieve reliable data.